Children who are developmentally delayed or who suffer from muscular/skeletal impairments often have difficulty standing and/or walking independently. For standing and/or walking they often use a variety of lightweight and portable devices such as walkers, canes and crutches. In some instances they may need standers for assisted standing and gait trainers for assisted walking.
Daily assisted standing and walking are beneficial and create the opportunity for good bone and muscle development. As compared to other positions such as sitting and lying, standing and walking allow many more possibilities for the disabled child to actively interact and initiate socially and physically within his/her environment.
However, many children, though, have no or limited access to these essential standers and gait trainers. They are costly, heavy and bulky. Further, they are generally designed for indoor use only. Thus, even if they are available at the child's home, (pre)school, or treatment clinic; they are rarely moved from location to location with the child.
The problems associated with the use of standers and gait trainers usually fall into at least the following three situations and their associated dilemmas.
In the first situation the child has access to a gait trainer and/or stander but, because of its size and/or weight it can not be easily transported with the child from location to location. Choosing to keep the child near the equipment during free time may provide the child with sufficient daily opportunities for assisted standing and walking, though unfortunately this common choice may sacrifice much of the child's contact with the outside environment including visits to family and friends, shopping and errands, long vacations, touring and travelling and even playgrounds. Further, this emphasis on the child's motor development may result in a negative influence on the young child's cognitive and social development and may limit the entire family's activities.
The second situation exists when the child is deprived of sufficient daily standing and gait training for either one of the two following reasons. First, the equipment may not be available because of cost, size and/or difficulty of transporting it between locations. Second, the equipment may be available, but the parents/caretakers do not plan the child's and family's daily activities in such a way that will keep the child within easy reach of the equipment. In both situations the child and family may have the advantage of increased mobility in the community with the benefit to the child of greater exposure to the environment outside of home and school. However, the child will probably spend increased time sitting in chairs, strollers, and wheelchairs and/or lying on the couch, bed or floor. As a result, the child may be denied a sufficient daily quantity of standing and gait training, thereby impeding improvement and maintenance of motor abilities.
The third situation effects children who normally ambulate using walkers, canes and crutches and want to participate in activities that demand that their hands be free. Standers and walkers currently being used demand that the children dedicate one or two hands to grasp it. Therefore, these devices are not useful for children who want or need for their hands to be free for activities while they are standing or walking.
Attempts to enable disabled children to stand and walk with their hands free are met by an adult either holding the child or by using a support harness, neither of which is satisfactory.
An adult, using one or two hands, may guide the child in standing or walking in any desired indoor or outdoor location. However, this type of assistance is exhausting and physically demanding for the adult.
When using a child's body harness, the adult must hold one or two hands above the child's shoulder, depending on how the harness is designed. This type of assistance is also exhausting and physically demanding for the adult.
Without the harness, the adult must support the child with two hands and either be on his/her knees, crouched, or bent over to accommodate the child's height. Compared to standing, gait training often demands that the adult assist the child with its leg movements in addition to providing balance and support at the trunk. It is difficult for one adult alone with or without a support harness to adequately provide for the child's needs in standing and gait training. Further, the adult's hands are not free for any other activities including the child.
Except when another able-bodied adult is present, when the adult wants to engage in an activity that requires adult involvement, the child's activity must be interrupted and the child must be moved to a sitting (when possible) or lying position so that the adult's hands are free. This is not desirable for the child and often is not possible in an outdoor environment.